Healthcare Provider Details

I. General information

NPI: 1255717195
Provider Name (Legal Business Name): RICHARD CASEY KOWALSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S KINGSLEY DR
LOS ANGELES CA
90005-2319
US

IV. Provider business mailing address

611 S KINGSLEY DR
LOS ANGELES CA
90005-2319
US

V. Phone/Fax

Practice location:
  • Phone: 213-201-1437
  • Fax: 213-201-1437
Mailing address:
  • Phone: 310-435-8892
  • Fax: 213-201-1437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH72855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: